fosfomycin + vancomycin

Fosfomycin + vancomycin is an antibiotic combination therapy that demonstrates synergistic bactericidal effects against various resistant gram-positive bacteria. The combination works through complementary mechanisms targeting different stages of bacterial cell wall synthesis. Vancomycin inhibits cell wall biosynthesis by binding to the terminal D-alanyl-D-alanine moieties of peptidoglycan precursors, while fosfomycin inhibits UDP-N-acetylglucosamine enolpyruvyl transferase (MurA), an enzyme involved in the first step of peptidoglycan synthesis. This combination has shown particular efficacy against vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and coagulase-negative staphylococci (CoNS).